Inside Steve Jobs' liver transplant

On Friday the Wall Street Journal reported, without indicating its source, that Apple (AAPL) CEO Steve Jobs underwent a liver transplant operation in Tennessee about two months ago.

This would seem to confirm a report in mid-January that Jobs — who had a tumor removed from his pancreas in 2004 and took a medical leave earlier in January to deal with continuing health issues — was considering such an operation, as well as rumors in mid-April that he was having the surgery in Memphis.

Two hospitals in Memphis are designated liver transplant centers: Le Bonheur Children’s Medical Center and Methodist University Hospital. Le Bonheur does not perform liver transplants on adults. A spokesperson for Methodist told the Journal that Jobs was not listed as a patient there, which leaves open the possibility that he was registered under another name.

About 6,000 liver transplant operations are performed in the United States each year at more than 100 hospitals, according to the Organ Procurement and Transplant Network, but the waiting list for donors is considerably shorter in Tennessee than it is in most states.

The operation usually takes five or six hours. The surgeon makes a large incision in the upper abdomen and removes the damaged liver by cutting all the attached ligaments and severing several vital ducts and vessels, including the common bile duct, the hepatic artery, the hepatic vein and the portal vein that carries blood to the liver from the spleen, stomach, pancreas and intestines.

Blood from the liver is replaced by an ice-cold solution until the organ can be replaced.

The new liver — usually rushed from a recently deceased donor in the kind of race against time regularly featured in TV medical dramas — is then placed in the empty cavity and attached to those vessels and ducts. [A growing percentage of hepatic transplantation procedures, as several readers have pointed out, are partial liver transplants from living donors.]

Recovery can take many weeks and the survival rate is good. 80% to 85% of patients live for at least a year; about 75% live for five years or more. (Recent studies report that the five-year survival rate at experienced transplant centers is over 90%.) To prevent rejection, most patients take immunosuppressive drugs for the rest of their lives.

Liver transplants are well-accepted treatments for end-stage liver disease and acute liver failure. The situation with Steve Jobs, who is recovering from a rare form of pancreatic cancer — called islet cell neuroendocrine tumor — may be a different story, as a key passage in the Journal piece suggests:

William Hawkins, a doctor specializing in pancreatic and gastrointestinal surgery at Washington University in St. Louis, Mo., said that the type of slow-growing pancreatic tumor Mr. Jobs had will commonly metastasize in another organ during a patient’s lifetime, and that the organ is usually the liver. “All total, 75% of patients are going to have the disease spread over the course of their life,” said Dr. Hawkins, who has not treated Mr. Jobs.

Getting a liver transplant to treat a metastasized neuroendocrine tumor is controversial because livers are scarce and the surgery’s efficacy as a cure hasn’t been proved, Dr. Hawkins added. He said that patients whose tumors have metastasized can live for as many as 10 years without any treatment so it is hard to determine how successful a transplant has been in curing the disease. (link)

If Jobs’ cancer did spread to his liver, the fact that he had this procedure suggests that it may not have gone any further. Most hospitals will not perform a transplant on patients with metastatic cancer that has spread outside the liver.

Apple continues to say that it looks forward to Steve’s return to Apple at the end of June, which is 10 days away. It has not yet returned a request for comment on this report.